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Abstract

Youth psychotherapy literature is in need of more research related to understanding psychotherapy process and outcome in child psychotherapy in community settings. The purpose of this study was to examine how key parenting skills were associated with child and adolescent symptoms and outcomes over the course of treatment in an outpatient community mental health system. Much of the research on child and adolescent outcomes has been conducted in controlled research settings, which raises the importance of more research needing to be done in representative clinical practice conditions (Weisz & Jensen, 2001). Further, few child and adolescent studies have examined potential mechanisms of change in child and adolescent psychotherapy (Kazdin & Nock, 2003), including moderators and mediators of the relation between parenting skills and child and adolescent outcomes.Participants included 407 youth, ages 4-17 (mean age = 9.7 years), and their parents or guardians, receiving routine outpatient mental health services in a community mental health setting. The youth sample included 51% males, 49% females. Measures used included the Youth Outcome Questionnaire (Y-OQ; Burlingame, Wells, Lambert, & Cox, 2004; Burlingame et al., 2001), and the Treatment Support Measure (TSM). Data were collected starting at the intake session, each of the first five therapy sessions, then every three weeks thereafter for six months post-intake. Parenting Skills items from the TSM included domains of overreactivity, laxness, verbosity, monitoring, consistency, and positive reinforcement. Hierarchical linear modeling was used to examine changes in parenting behaviors and youth symptoms. Results indicated that parenting skills significantly improved over the course of treatment (p < .001) and best fit a logarithmic (natural log) function, such that most of the reported change in parenting skills occurred during the first few sessions of treatment. Further, there was a significant inverse relationship at intake between parenting skills and Y-OQ scores; specifically, lower parenting skills scores were associated with higher Y-OQ scores for parent and youth report (p < .001; p = .033). In addition, parenting skills at intake were associated with the subsequent rate of change of youth symptoms for parent report (p < .001) and youth report (p = .026). Lastly, improvements in parenting scores were associated with improved youth symptoms over the course of treatment for parent and youth report of symptoms (p = .021; p = .02). These findings can be generalized to other community outpatient settings and highlight the importance of attending to parenting skills as an avenue to improving child psychotherapy outcomes. Specifically, the results of this study emphasize the importance of parents implementing effective parenting skills and its influence on their child's overall symptoms at intake and outcomes in therapy.